References
Stay on the ambulance long enough and you'll go full circle: an evaluation of the clinical safety and effectiveness of non-emergency and multi-occupancy ambulance conveyance in non-emergency percutaneous coronary intervention patients
Abstract
Mechanisms to facilitate rapid ambulance transport of diagnosed STEMI patients from the community and emergency departments (ED) settings directly to primary percutaneous coronary intervention (PPCI) facilities are well established within NHS Ambulance Services. Direct challenge of inter-hospital transfer requests for non-emergency percutaneous coronary intervention (PCI) patients by a regional NHS Ambulance Service identified disagreement between peripheral feeder hospitals and the NHS Ambulance Service on what level of ambulance transport is most appropriate.
To reduce unnecessary peripheral feeder hospital requests for paramedic emergency service transfer and resource utilisation in non-emergency PCI patients and to assess the clinical safety of both non-emergency transport and multi-occupancy conveyance for this patient group.
A process was established with a regional cardiothoracic centre to support pre-screening of non-emergency PCI patients for conveyance via non-emergency ambulance resources and multi-occupancy. This included centralisation of all non-emergency PCI ambulance transport booking practices and dissemination of learning materials on the process to all stakeholders. During the three-year period 3172 patients were identified as suitable for conveyance by both non-emergency ambulance transports. Of this, 36% (n=1767) were conveyed as part of a multi-occupancy journey and 56% (n=782) were conveyed by non-emergency resources. Overall, 69% (n=782) of all multi-occupancy conveyances were undertaken by non-emergency resources. Two clinical incidents were noted during this period, both of which were managed via clinical telephone advice.
Non-emergency ambulances can be safely used to transport non-emergency PCI patients via multi-occupancy, following appropriate pre-screening by the receiving PCI unit. Further work is needed to understand the feasibility of this across other patient groups in the inter-hospital transfer scenario and its transferability to other NHS Ambulance Services.
Angina pectoris and acute myocardial infarction (AMI) are the two primary manifestations of coronary artery disease (Richter et al, 2015), with AMI split into two categories: acute ST-segment elevated myocardial infarction (STEMI) involves a significant or major epicardial vessel occlusion, and non-acute ST-segment elevated myocardial infarction (NSTEMI) falls short of major epicardial vessel occlusion (Purcell and Kalra, 2005; Richter et al, 2015). The timely restoration of antegrade blood flow in the affected coronary artery via fibrinolytic therapy or PPCI in STEMI is significant in reducing the risks of mortality, with PPCI already established as a “gold standard” therapy (Keeley et al, 2003; Lee et al, 2010; McClean et al, 2011; Steg et al, 2012; Austin et al, 2014). However, not all patients present to emergency care systems upon the onset of symptoms, despite national campaigns outlining the symptoms of AMI.
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